EN
繁中
PIAF Alignment Studio
North Point, Hong Kong
EN
繁中
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Part 1: Your details
Name
*
(Required)
Phone number
*
(Required)
Email address
*
(Required)
How would you like us to contact you?
*
(Required)
WhatsApp
Phone call
Email
Which day would you like to come in?
*
(Required)
Our physiotherapist is in on Tuesdays and Saturdays. The earliest you can choose is three days from today. If you are flexible, ask for the earliest slot instead.
As soon as possible, the earliest Tuesday or Saturday slot
What time suits you?
*
(Required)
Pick a day in the calendar above to see the times for that day.
Part 2: About your pain or injury
Where is the main problem?
*
(Required)
Have you had an injury before?
*
(Required)
No
Yes
Roughly when did it start?
For example: two years ago, last week, or long-term strain
How long have you had this pain?
*
(Required)
What does the pain feel like? (choose any)
*
(Required)
Sharp or stabbing
Dull ache
Numbness or pins and needles
Muscle stiffness
Pulling or tightness
Pain score (0–10)
*
(Required)
0 is no pain, 10 is the worst pain
0
1
2
3
4
5
6
7
8
9
10
No pain
Worst pain
What movements or positions bring the pain on?
What movements or positions ease the pain?
Do you do any regular exercise or training?
For example: Pilates, barre, running, weights
Part 3: Health history and safety check
Do you have any long-term conditions, or take any medication?
Have you had any recent scans (X-ray, MRI, CT)?
*
(Required)
Yes (please bring the report or images on the day)
No
Do you have any of these symptoms? (If so, please see a doctor first)
*
(Required)
Sudden weight loss without a known cause
Bladder or bowel problems (incontinence or unable to pass urine)
Night pain that badly disturbs your sleep
Severe numbness or weakness in a limb without a known cause
None of these
Have you had any surgery, or do you have any allergies?
Part 4: Your goals and consent
What would you most like to achieve from physiotherapy?
Consent
*
(Required)
I confirm the information I have given is true, and I understand it will be kept strictly confidential and used only for my physiotherapy assessment.
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